Clinical Review

Recent advances: hiv infection—I

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7079.487 (Published 15 February 1997) Cite this as: BMJ 1997;314:487
  1. Jonathan Allen Cohn, assistant professor (JCohn@oncgate.roc.wayne.edu)a
  1. a School of Medicine Wayne State University 4201 St Antoine UHC-7D Detroit MI 48201-2907 USA

    Introduction

    Impressive advances in the understanding of the virology and immunology of HIV infection have led to new treatments, new methods to monitor treatment, and new optimism regarding the treatment of early HIV infection. Although controversial, the possibility of curing HIV infection in selected patients by using existing technology was discussed at the 1996 international AIDS conference in Vancouver, Canada. However, the substantial expense, toxicity, and inconvenience of the new treatments make many clinicians and patients more cautious than are the investigators regarding the potential effectiveness of these new approaches. Further, 90% of the 22 million people with HIV infection worldwide live in societies without the financial resources to pay the current price for these treatments, and others in developed nations may lack access due to a lack of, or limitations on, health insurance. In industrialised nations, we can work with our patients to take advantage of the lessons learnt in the past year.

    Can HIV infection be cured?

    At the eleventh international AIDS conference in Vancouver, Canada, several investigators presented theory or data regarding the possibility of eradicating HIV infection by the aggressive use of combination antiretroviral treatment. David Ho discussed the steady state model of HIV infection derived from studies of viral replication and turnover in treated patients. Susceptible CD4 lymphocytes become infected with HIV and most develop productive infection, leading one and a half days later to a release of a large number of new virions and the death of the host cell (fig 1). These virions are cleared from plasma with a half life of about six hours and initiate a new round of infection in susceptible CD4 cells, predominantly within lymphoid tissue. Ho and colleagues estimate that 99% of the virus found in the plasma is derived from this cycle.1 Using this model, Perelson et al have estimated that 10 …

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